Tips on EM presentations skills

Students have already had a few years of being taught by other departments how to do an oral presentation, but it may not be applicable to EM.

Majority of the student and resident educational interactions with attending physicians in EM occur during oral presentation.

Student evaluation is directly linked to how well the student presents.

About the article

The authors are using their success to assist learners present all pertinent information in under 4 minutes

History of the Oral presentation

Earliest mention of the oral presentation is from the dean of the New Orleans Medical School, Erasmus Fenner, in 1846, though it seems intuitive that doctors and learners have been communicating with oral presentations much longer than about 200 years.

In 2003, the SNAPPS format of presentations was developed at Case Western Reserve University School of Medicine. This format was designed for outpatient oral presentations. The SNAPPS method focuses on

brief patient summaries

Narrowing DDx of 2-3 etiologies

Analyzing information to determine the most likely cause of chief complaint

Probing the attending for knowledge

Planning pt management

Selecting an issue for self-directed learning

Students noted that:

Effective presenters alter the way they present but had difficulty describing how, making it difficult for novices to mimic

EM

The origins of the oral presentation and the recent studies noted previously are not EM specific

In EM we:

Assume every patient has an emergent condition

Have multiple undifferentiated patients at once

Prioritize patients

Have incomplete patient data

EM Oral Presentations – How are we different?

CC

HPI

Meds/allergies

PE

Summary statement

Assessment and plan

What is minimized are

PMHx,

PSHx

Soc Hx

FmHx

ROS

Essentially, the HPI should include all the pertinent information from those areas that are minimized.

Earlier learners will still have items that are positive in the ROS, as they may not be aware of what is pertinent and what is not.

To further improve speed, the student should include only pertinent positives and negatives on physical exam.

The 3 Minute Emergency Medicine Medical Student Presentation: A variation on a theme.

What is the K2 Krash – it’s the phenomenon of hypotension and bradycardia after a synthetic cannabinoid overdose. Typically an overdose with hypotension and bradycardia is a life-threatening phenomenon, for example calcium channel blockers and beta blockers. K2 crash seems to be less life-threatening and responds well to fluid resuscitation unlike other poisonings with the same cardiovascular effect.

I suggest you follow Leon Gussow’s tip on managing hypotension in overdoses – scan the IVC and fill up the tank until the respiratory collapse of the IVC is replaced with a plump IVC and then add pressors if needed or wait out the metabolism of the synthetic cannabinoid. Typically the clinical course of hypotension is less than six hours.

We do know that the K2 Krash is the result of stimulus of the CB1 receptor. We also know that endogenous cannabinoids are released by platelets and macrophages during sepsis. Whether they in fact have a protective effect remains to be seen, but they appear to result in vasodilation of the brain and coronary vasculature. Perhaps that’s why K2 Krash appears to be a relatively benign event once it resolves.